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Getting Clarity on Surgical Costs

Pricing practices from healthcare providers fluctuates frequently. Hospitals often bill different insurance payers varying prices for the same services. In some cases, insured patients receive a higher bill to subsidize the gaps left by uninsured patients. Other times, a specific provider’s cost can simply vary drastically from other providers performing the same procedures and services [1].

For inpatient surgical procedures, it’s not uncommon for a patient to receive multiple bills. A typical surgical procedure can result in separate bills for surgeon charges, assistant surgeon charges, anesthesia costs, imaging costs, and facility charges. With all the moving parts, confusion amongst patients can be unavoidable.

Lack of information or general misunderstanding surrounding the true cost of surgical procedures can often lead to unexpected medical bills. TransUnion Healthcare recently released information that asserted 76% of Americans are concerned about healthcare costs and the financial strain that may be associated with them [2]. It’s also been reported that Americans face higher-than-average out-of-pocket medical costs. These medical expenses equate to nearly 3% of a household’s total budget [3].

With the rising costs of healthcare and the growth of high-deductible insurance plans, consumers have adopted a heightened sense of awareness and have become more price-conscious. Crain’s has reported that high-deductible insurance plans make up more than 35% of all commercial insurance. That’s up from less than 7% only five years prior [4]. The high-deductible plans have also impacted an insured patient’s ability to pay for medical expenses in many cases. Kaiser Family Foundation and The New York Times reported that 75% of people who had problems paying for medical bills while insured said copays, coinsurance, or deductibles were more than they could afford [5].

Out of necessity, more and more patients aim to be informed about medical costs prior to incurring them. According to a report released by Rally Health, 75% of people with a deductible larger than $3,000 say they have tried to obtain pricing information prior to receiving care [6].

While the demand for price disclosure from medical providers is on the rise, transparency in pricing is not always attainable. It is common practice for medical providers and insurers to not reveal the cost of care until after it is performed.

With the BridgeHealth surgery benefit program, Plan Members are provided pre-negotiated case rates for surgical procedures. These bundled case rates help to contain costs and eliminates pricing unpredictability, allowing our Plan Members to make informed decisions about their healthcare. Plan Members also benefit from the high-quality hospital providers. BridgeHealth partners exclusively with the top 25% of hospital providers in the country [7].